Modified diets Flashcards
Mechanically altered diets
Routinely prescribed for individuals with
chewing or swallowing difficulties
– Pureed diet (don't need to chew): contains foods pureed to pudding-like consistency e.g. pureed winter squash, mashed potatoes/ sweet potatoes.
– Mechanical soft diet (less chewing than regular diet): contains ground or minced foods or moist, soft-textured foods
– Blenderized diet: includes foods from all food groups, often with added liquid
Liquid diets
• Clear liquid diet
– This consists of clear liquids which do not leave intestinal residual e.g. water, gelatin and juices without pulp, tea and ice chips
• Full liquid diet
– Similar to clear liquid diet but includes milk & other opaque liquids
– May be transitional diet between clear liquid & solid foods
• Diet progression: change in diet to adapt to patient’s tolerance to foods
Dry mouth
– Causes • Reduced salivary flow • Autoimmune diseases • Radiation therapy • Mouth breathing – Consequences
- Impairment of health & quality of life
- Associated with increased plaque, tooth decay, gum disease, mouth infections
- Interferes with speech
- Makes chewing & swallowing more difficult
- Discomfort of denture fit; development of ulcerations in mouth
Dysphagia
– Causes
• Neurological diseases & disorders
• Surgical procedures
• Physiological or anatomical abnormalities
– Types
• Oropharyngeal dysphagia
• Esophageal dysphagia
– Complications • Aspiration • Airway obstruction • Choking • Respiratory infections • Reduced food consumption, malnutrition & weight loss
National dysphagia diet
• Level 1: Dysphagia Pureed
– Foods pureed, homogeneous & cohesive
– Diet for patients with moderate-to-severe dysphagia & poor oral or chewing ability
• Level 2: Dysphagia Mechanically Altered
– Foods moist & soft textured; foods easily form a bolus
– Diet for patients with mild-to-moderate dysphagia; some chewing ability required
• Level 3: Dysphagia Advanced
– Foods moist & in bite-sized pieces when swallowed
– Individuals using diet need to tolerate mixed food
textures
– Diet for patients with mild dysphagia
Dysphagia Diet(con’t)
• Liquid Consistencies
- Thin = watery
- Nectarlike = fluids thicker than water
- Honeylike = fluids that can be eaten with a spoon, don’t hold their shape
- Spoonlike = Thick fluids that hold their shape
– Feeding strategies
• Depends on nature of swallowing problem
• Strengthening exercises of jaws, tongue or larynx
• Changing position of head & neck while eating
• Learn new methods of swallowing
– Speech & language therapists often
responsible for teaching patients techniques &
strategies to improve feeding
Gastrectomy
– Surgical removal of diseased portions of the stomach (partial gastrectomy) or entire stomach (total gastrectomy)
– Other gastric resection procedures to treat complications of ulcers
• Vagotomy
• Pyloroplasty
Postgastrectomy diet
- All foods & fluids withheld until some healing has occurred
- Immediately after surgery: IV fluids, with careful monitoring of fluid balance
- 24-48 hours after surgery: ice chips or small sips of water
- 4-5th day after surgery: liquids, progressing to solid foods when tolerated; tube feedings if unable to progress to solid foods
- Adjustments influenced by size of remaining stomach & rapid gastric emptying that results
Gastrectomy dietary adjustments
- Smaller stomach limits meal size; affects food tolerance because of potential for dumping syndrome
- Several small meals & snacks containing only one or two food types
- Inclusion of protein, fats, complex carbohydrates
- Slow progression to 5-6 meals per day
- Avoidance of sugars & sweets
- Avoidance of milk products if lactose intolerant
- Addition of fiber to delay stomach emptying and reduce diarrhea
• Some patients experience problems with fatty foods, highly spiced foods, carbonated beverages, caffeine-containing beverages, alcohol, extreme temperatures, peppermint &
chocolate
Complication of Gastrectomy
- Substantial weight loss
- Fat malabsorption
- Bone disease
- Anemia
Dumping syndrome
–Common complication of gastrectomy & gastric bypass surgery
– Group of symptoms resulting from abnormally rapid gastric emptying
– Hypertonic gastric contents rush into small intestine more quickly after meals, resulting in unpleasant effects
–Symptoms of dumping syndrome may occur within 30 minutes of meal
Bariatric surgery
– Surgical treatment for severe obesity
– Gastric bypass surgery (roux-en-Y) popular option
• Creation of small gastric pouch
• Reduces gastric capacity, restricting meal size
• Also creates bypass of part of small intestine, restricting absorptive capacity
• Helps to achieve long-term weight loss
– Dietary guidelines after bariatric surgery
• Gradual expansion of gastric pouch to increase capacity to approximately 1 cup; initially only few tablespoons
• Initially post-op: ice chips & sips of water
• Progress to liquid diet for first 1-2 weeks (small, frequent meals)
• Followed by pureed foods, progressing to soft, then regular foods
• Some foods difficult to manage
Patient education & counseling critical for weight loss & management for bariatric surgery
- Food portion control to avoid dumping syndrome & to maintain weight loss
- Elements of healthy diet
- Foods that may cause discomfort, vomiting or dumping
- Dietary supplements
Post-surgical concerns for bariatric surgery
- Dumping syndrome
- Fat malabsorption
- Multiple nutrient deficiencies
- Rapid weight loss increasing risk of gallbladder disease
- Plastic surgery to remove extra skin after weight loss
Inability to grasp
• Special equipment to assist with feeding
– Adaptive devices make remarkable difference in person’s ability to eat independently; usually assessed by the Occupational Therapist
• Utensils
• Plates
• Cups
• Specialized chairs & bolsters
– If food consumption remains inadequate, tube feedings may be require
